Symptoms
The symptoms of acute and chronic leukemias are mostly non-specific and are observed in connection with other diseases. There are, however, various warnings that make one think of leukemia and should be taken seriously. The severity of the symptoms varies depending on the form of the disease.
While acute leukemias occur suddenly and suddenly, chronic leukemias remain undetected for a long time and are only discovered during routine medical examinations. Acute leukaemia is usually preceded by complete health before the onset of an uninterrupted high fever and a distinct feeling of illness with an increased tendency to infections, which otherwise do not occur in people with an intact immune system. The course of chronic leukemia is much slower and less obvious.
Patients usually experience only minor restrictions in their daily life. In general, those affected often feel tired and complain of reduced performance. Physical symptoms can be observed in the form of the so-called B-symptoms of cancer.
The term summarizes the triad of unintentional weight loss, persistent fever and night sweats. Faulty control mechanisms lead to the uncontrolled multiplication and production of immature white blood cells. As a result, anemia (lack of blood) develops, which is accompanied by the following symptoms: paleness, high heart rate, dizziness and increased shortness of breath.
In addition to mature white and red blood cells, less functional thrombocytes (blood platelets) are produced due to the displacement mechanism. Those affected suffer more frequently from bleeding in the mucous membranes of the nose and mouth. Even slight trauma is sufficient to cause hematomas under the skin.Small punctiform bleedings on arms and legs, so-called petechiae, are also the result of a reduced ability to clot. Other symptoms that can indicate leukemia are increased susceptibility to infections, skin rashes, swollen lymph nodes, painful bones and a palpably enlarged spleen or liver.
How to detect leukemia in infants and babies?
In Germany, about 600 children and adolescents up to the age of 18 fall ill with leukemia every year. The symptoms of an incipient leukemia are unspecifically similar to those of an adult. The children can be tired and pale more often and are generally more susceptible to infections.
Fever, night sweats and unintentional weight loss are part of the so-called B-symptoms, which can occur in leukemia or other tumor diseases. Children may also complain of bone pain and bleed faster and more frequently than usual, e.g. from the nose, or get bruises (haematomas). As in adults, children and babies can develop swollen lymph nodes and an enlarged spleen or liver as part of leukemia.
Other general symptoms such as loss of appetite or feeling unwell and listless may also occur. Around 30% of all cancers at this age are due to malignant neoplasms of the haematopoietic system. In children up to the age of 14, acute lymphatic leukemia accounts for by far the largest proportion, with 500 new cases per year.
According to statistical data, the majority of the diseases are in children between one and five years of age. Adults are affected much less frequently. Thanks to modern therapy options, the chances of being disease-free after 5 years are about 90%.
Acute lymphatic leukemia (ALL) is based on the production of degenerated lymphocytes. Different forms are distinguished. Depending on which progenitor cells are affected by B- or T-lymphocytes, the course and prognosis can vary considerably.
The exact subdivision into different subforms of ALL is a helpful tool in choosing the right treatment. The causes for the development of ALL have not yet been sufficiently clarified. Genetic and external factors such as viral infections and radioactive radiation seem to play a role in the genesis of the disease.
Children with congenital disorders of the immune system and chromosomal anomalies are also more likely to develop leukemia. When diagnosing leukemia, a precise blood count analysis and a bone marrow puncture are indicated in addition to the medical history and clinical examination. Furthermore, imaging procedures such as X-ray examinations, magnetic resonance imaging (MRI) and computed tomography (CT) are used.
If ALL is detected, treatment takes place in a special facility for pediatric oncology cases. The central component of the therapy of each subtype is chemotherapy. Cell growth is inhibited with the help of so-called cytostatic drugs.
Each therapy is adapted to the individual spread of the tumor. In addition to cytostatic drugs, radiotherapy and, under certain circumstances, stem cell transplantation can be used. In Germany, about 110 children and adolescents fall ill with acute myeloid leukemia every year.
At around 20%, it makes up the second largest proportion of leukemias. Especially infants and toddlers up to the age of two years are the most numerous. Causes and diagnosis are comparable to ALL.
The most important part of the therapy of AML is drug-based chemotherapy, which is rarely supplemented by other measures. The chance of recovery after 5 years is 70%. If leukemia is suspected, the physician initiates various examination steps.
In addition to the medical history and physical examination, an exact blood count and bone marrow puncture play an important role. If the suspicion of a certain form of leukemia is confirmed, the results of the blood and bone marrow tests in particular provide decisive indications for further treatment measures. Blood count analysis is used to determine red and white blood cells and platelets.
In this way, it is possible to assess whether and which subtype of white blood cells is subject to malignant changes. In the so-called differential blood count, not only the morphology (appearance) of the individual leukocyte subgroups is determined, but also their proportion of the total number of white blood cells. Granulocytes are part of our innate immune system and can be divided into eosinophil, basophil and neutrophil granulocytes.They make up about 60% of the leukocytes.
Lymphocytes are the second most common and belong to the acquired immune defense. Monocytes are also called scavenger cells and account for only a few percentage points. The blood count does not always show a significant increase in the number of white blood cells (leukocytosis).
Normal as well as decreased values (leukopenia) are also not uncommon. The various precursor cells of the blood cells mature from the stem cells in the bone marrow. Only at the end of their differentiation into functional cells are they released into the bloodstream.
In malignant neoplasms of the bone marrow, precursors are increasingly found in the blood. A decrease in the number of red blood cells (anemia) and platelets (thrombocytopenia) is often observed. This is related to the displacement by the malignant proliferation of leukocytes.
On the other hand, leukemia can also be accompanied by erythrocytosis or thrombocytosis, i.e. an increased number of red blood cells and platelets. Although blood count analysis is an important part of the diagnosis of leukemia, it is not always a reliable tool. An inconspicuous laboratory does not have to be an exclusion for leukemia.
Conversely, not every abnormality is a sure sign of leukemia. Other diseases are also associated with changes in the blood count.
